Brief Answer:
I would explain as follows:

Detailed Answer:

Hello!

Thank you for asking on HCM!

Regarding your concern, I would like to explain that dysopiramide is considered superior to other negative inotropes (beta-blockers and calcium channel blockers) in reducing intraventricular pressure gradients in patients with hypertrophic obstructive cardiomyopathy.

That's why it is considered a last preferred therapeutical choice before a more radical treatment like surgical myectomy or septal ablation procedure.

BUT, from the other side, disopyramide has a great potential for adverse effects, which sometimes lead to withdrawal of the drug.

Returning to your concrete clinical scenario (overwhelmingly tired), I would explain that we have to rule in/out a possible side effect of disopyramide.

Disopyramide may cause tiredness and extreme fatigue by several ways:

(1) Because of its anticholinergic properties, it may induce hypotension (especially orthostatic hypotension), due to its negative inotropic effects it may deteriorate a previously impaired LV systolic function leading to acute heart failure.

(2) Because of stimulating insulin secretion, it may induce hypoglicemia and thus leading to extreme tiredness, nervousness, etc.

(3) It may induce sometimes hepatic damages, leading to an inflammatory state during the first week of treatment, manifested with malaise, dark urine, etc.

(4) Other possible systemic involvements, like myopathy (muscles ache), nervous system (depression, neuropathy, etc).


Coming to this point, and directly addressing your question, I would explain that first of all we need to identify which of the above mechanisms is responsible for extreme tiredness.

You need to discuss with your prescribing physician, as a comprehensive differential diagnosis should be made.

You need to closely monitor your blood pressure values during the day. If abnormally low BP values are identified during episodes of tiredness, then a possibly hypotension is the cause. In such case addition of Pyridostigmine (under medical supervision) to Disopyramide would relieve anticholinergic effects and avoid unpleasant tiredness.

It is also necessary to check, blood glucose (for possible hypoglycemia), liver function tests (to rule in/out a hepatic dysfunction), some other enzymes like LDH, CPK to exclude possible myopathy, blood electrolytes, etc.

So, you need to speak to your doctor about the above mentioned option to better help on discriminating the offending factor.

Depending on the factor, a decision will be made on Disopyramide continuation.

If anticholinergic effects will remain responsible, then a drug continuation will be possible by adding Pyridostigmine.

If other side effects are responsible for symptomatology, then another option of your cardiomyopathy will come to discussion. Surgical myectomy or septal ablation are reasonable options.

Hope to have been helpful to you!

Feel free to ask me whenever you need! Greetings! Dr. Iliri

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